Sue Turale

Readiness for self-directed learning among nursing students in Thailand.

This study took place in Thailand where didactic and lecture-driven teaching styles are beginning to transform into student-centered methods. At Chiang Mai University Faculty of Nursing in Thailand, the readiness of 272 undergraduate students to undertake self-directed learning was investigated using two instruments: a demographic data questionnaire and Guglielminos Self Directed Learning Readiness Scale. The study found that the overall self-directed learning readiness of participants was at a high level in the categories of openness to learning opportunities, self-concept as an effective learner, initiative and independence in learning, informed acceptance of responsibility for ones own learning, creativity, and the ability to use basic study and problem-solving skills. The findings provide encouragement to nurse educators to further apply self-directed learning in nursing courses, to improve teaching and learning methods, and promote life-long learning for nurses within Thailand and elsewhere.

Nursing scholarship in Japan: Development, facilitators, and barriers

This qualitative study sought a contemporary view of the development, facilitators of, and barriers to nursing scholarship in Japan from the perspectives of the scholars. In-depth interviews were conducted with 13 scholars across Japan, which were digitally recorded, and the data were subjected to content analysis. Five themes emerged: a spirit of collectivism; a lack of nursing control; a lack of English ability; a high workload; and collaboration. The participants considered that culturally based consensus and communication behaviors, as well as the control and dominance by the medical profession, were hampering nursing scholarship. Furthermore, Japanese nurses were not in control of the profession in a period of unprecedented growth in university nursing education and a growing nursing shortage. A lack of English-speaking and English-writing abilities hindered collaboration with scholars internationally and the writing of international publications. Most of the participants felt unable to compare the extent and nature of Japanese scholarship with that of their Asian neighbors. The Japanese scholars need to grasp opportunities to learn English, collaborate with other nurses nationally and internationally, learn assertion and political skills to give them the confidence to take control of nursing education, and be more involved in research collaboration and international publications.

Short-term behavioral changes in pregnant women after a quit-smoking program via e-learning: A descriptive study from Japan

Approximately 20% of Japanese women in their reproductive years are smokers. Therefore, in the present study, we report the behavioral changes of woman who undertook a 3 month stop-smoking program. Sixty-six pregnant smokers in the first trimester of pregnancy participated in this study from two hospitals and an obstetric clinic in Japan. Our newly-developed e-learning program uses a cell phone Internet connection service to support pregnant women who want to quit smoking. Using this, service participants were given guidance concerning smoking, and were breath tested for their carbon monoxide levels every 4 weeks for 3 months. An e-learning cessation smoking-support program was maintained throughout the same period. Consequently, 52 of 66 pregnant smokers from three settings began the program, and 48 of 52 eventually completed it. The achievement rate of non-smoking was 71.1% (37/48), and their carbon monoxide exhalation levels significantly decreased from 6.43 ± 4.5 ppm at the beginning to 0.7 ± 1.0 ppm in 1 month, to 0.29 ± 1.08 in 3 months (P < 0.001). These results suggest the effectiveness of our e-leaning program. This paper reports the results of the study.

Review Article: Genetic competence of midwives in the UK and Japan

In the UK and Japan, midwives provide health services for women with concerns about a genetic condition or who are considering antenatal screening. In both countries, competences related to genetic health care have been devised but there is little evidence about midwifery competence in practice. A systematic literature review was undertaken to determine the extent to which midwives are achieving the genetic competences that are prescribed for their practice. English and Japanese literature from January 1999 to March 2009 was retrieved. Original studies or reviews, in which an aspect of midwifery practice was related to genetic competences, were eligible for inclusion. After a critical appraisal, six UK and five Japanese papers were eligible for inclusion. The findings indicated that midwives are not achieving the competences, nor are they confident about their genetics knowledge. Moreover, women are not being supported to make informed decisions regarding antenatal screening. We have confirmed that little research is being undertaken in both countries regarding competency achievement in practice. Changes to midwifery curricula and further continuing education are required to ensure that midwives are able to provide effective care regarding genetics.

Genetic competence of midwives in the UK and Japan.

In the UK and Japan, midwives provide health services for women with concerns about a genetic condition or who are considering antenatal screening. In both countries, competences related to genetic health care have been devised but there is little evidence about midwifery competence in practice. A systematic literature review was undertaken to determine the extent to which midwives are achieving the genetic competences that are prescribed for their practice. English and Japanese literature from January 1999 to March 2009 was retrieved. Original studies or reviews, in which an aspect of midwifery practice was related to genetic competences, were eligible for inclusion. After a critical appraisal, six UK and five Japanese papers were eligible for inclusion. The findings indicated that midwives are not achieving the competences, nor are they confident about their genetics knowledge. Moreover, women are not being supported to make informed decisions regarding antenatal screening. We have confirmed that little research is being undertaken in both countries regarding competency achievement in practice. Changes to midwifery curricula and further continuing education are required to ensure that midwives are able to provide effective care regarding genetics.

Disaster training for nurses: a moral and humanitarian imperative

Disaster training for nurses: a moral and humanitarian imperative I am sure you do not need reminding of the large-scale disasters that have plagued our planet in recent years. Global warming has played a large part in this with historic temperature variations occurring in many parts of the world, like recent snow on the pyramids of Giza, and increases in adverse weather events, such as heavy rains, floods, and typhoons. For example, the huge Typhoon Haiyan (Yolanda) hit the Philippines on 8 November 2013, eventually continuing its destructive path into Vietnam. Typhoons seem to be growing in intensity in the Asia-Pacific region, and often hit areas where people are poor and local infrastructure is limited. This typhoon was the deadliest on record to affect the Philippines. As I write this editorial, bodies are still being found, and health systems are struggling to cope with the health needs of the population, especially as immediate international relief efforts wind down. Of course there are many other types of disasters and nurses like all other health professionals need to be better equipped to deal with their aftermath. While it is not in our power to stop such terrible events in the natural world, it is in our power to be better prepared to help communities deal with losses and ongoing effects. We also can be better prepared to help ourselves, for nurses are victims of disaster, too. Although the awareness of nurses regarding disaster preparation has grown around the world over the last decade, most nurses are not yet prepared, educationally or psychologically, to respond to disasters, despite scientists warning us that such disasters will continue with possibly greater catastrophic events in the 21 century. Little is known about the numbers of nurses who were gravely affected by the typhoon, and needing direct assistance (Philippine Nurses Association 2013). This was truly a catastrophic event and while our hearts might go out to our colleagues in the Philippines and Vietnam, such sentiments are not enough. We must help nurses in these troubled areas to cope and be prepared for future disasters. Unfortunately around the world we have only made very small inroads into providing nurses with appropriate disaster nursing education and training at undergraduate and graduate levels, and in courses offered within health systems. ‘Health systems and health care delivery in disaster situations are only successful when nurses have the fundamental disaster competencies or abilities to rapidly and effectively respond’ (World Health Organization and International Council of Nurses 2009, p. 6). Capacity building in nursing and midwifery is needed to help limit injury and death, and provide for the ongoing health and well being of communities long after the disaster event. For example, the psychological effects of disasters often last for many years, and nurses need to be trained in psychological first aid, just as they are trained in physical first aid. Nurses have a major role to play in risk assessment and in helping communities be better prepared for disasters, large or small. I hope that everyone who reads this editorial will take steps to prepare nurses and midwives for disasters of the future, for these will pose serious and ongoing public health risks wherever they occur. We need to take urgent and critical action in all countries to ensure that nursing curricula contain some element of disaster nursing. The ICN Framework for Disaster Nursing Competencies (2009) will help in designing such courses. Specific courses for disaster nursing have been instigated in a number of countries, but often in more developed countries. Nurses need to make international efforts in this capacity building, and this involves advocating, policy-making, research, programme design and implementation. Since we are the largest group of health professionals globally, it is within our power to bring to the attention of politicians and policy-makers the urgent need to prepare nurses for disasters. After all if we don’t do it, who will? The only certain thing about disasters is that they will happen in the future, so do your best to help nurses of the world be better prepared. I believe that this is one of our moral and humanitarian imperatives of the 21 Century.

Factors influencing the development of a Thai health-promoting faculty of nursing: an ethnographic exploration.

Universities can make a significant contribution to improve population health through encouraging faculty members and universities to focus on health promotion, using a health-promoting framework. This qualitative study explored factors influencing the development of a health-promoting nursing faculty in a Thai university. Data were collected via in-depth interviews of 15 nursing academics and four academic support staff, and fieldwork observations. Data were analyzed using Spradleys ethnographic approach. Findings included informants perceiving that the achievement of a health-promoting educational organization is dependent on a number of contexts, including the presence of the national health policy regarding health promotion, the policies and actions of a university, faculty administrative contexts, organizational culture, ThaiHealth actions and support, profession-related factors, time limitations, the physical environment, and personal factors. Moreover, the development of health-promoting faculty within nursing should be based on the existing support in a university and faculty. Factors impeding such development must determine whether health promotion and well-being are to be achieved as a foundation for faculty work, and the mission of a university within a healthy settings approach.

Preparing nurses for the 21st century: reflecting on nursing shortages and other challenges in practice and education.

In over 40 years in nursing, I have seen many changes in practice and education. What dynamic times we live in, for nothing seems to remain stable for long. We can never say with confidence:“Well, we have really achieved our goals, and fixed the problems in nursing”. In this extended Editorial, I comment on challenges in practice and education that need to be overcome to ensure nurses are better prepared for practice. The last decade, in particular, has seen ongoing debate about the challenges and issues confronting the preparation of nurses around the world. This debate is stimulated by many factors, including growing shortages of nurses in many countries, as clinicians and educators; significant advances in biomedical sciences and technology; and the realization that being admitted to hospital is not always a safe option when there are not enough competent practitioners. There is clear evidence that nurses not being prepared to meet the needs of caring in the 21st century in many countries (International Council of Nurses, 2010), and Bartels (2005, p. 222) commented: “We are still teaching nurses to work in settings where they might not be working in the future, preparing them for work they soon might not be doing”. Today, we are still seeing low levels of nurses involved in primary health care and health promotion, compared to those working in secondary and tertiary health systems, thus reducing the capacity to prevent health problems and encourage healthier lifestyles. In addition, there is increasing throughput of patients in many hospitals. Nurses find it difficult to form caring relationships, and students may struggle to gain an holistic clinical experience when a patient is hospitalized for only a day or two; sometimes just overnight.These matters all challenge healthcare systems and the health workforce on many levels, including preparing nurses for changes in practice. Health workforce shortages involve both nurses and other disciplines, and I have noticed that the literature has grown considerably regarding this phenomenon in the last 10 years. Safe quality care is compromised when there are less nurses available, and in NHS and other journals, there are growing numbers of articles related to the various aspects of safety in nursing. The preparation of nurses clearly needs to ensure that safety is an underlying foundation for practice (Sherwood, 2010). In my career, I have witnessed serious neglect of peoples’ health in both developed and developing countries because of the lack of enough qualified staff,but the issue of sufficient and competent nurses is complex, dynamic, and varies between localities. For example, I have just been teaching in the Philippines where there is a significant oversupply of registered nurses who cannot find work in their own country or elsewhere.The Philippine Nursing Association President, Dr Teresita Barcelo, is quoted as saying that many countries had imposed stricter rules on hiring foreign nurses, and currently, 287,000 Filipino nurses are jobless (The Philippine Star,2011). Filipino nurses are very poorly paid, and many are now working as volunteer nurses across the country. While this might be beneficial for communities, it does little to convince the government to try to release funding for more full-time nursing positions, or try to ensure adequate reward for services rendered after gaining a 4-year degree. The Philippines has been an active exporter of nurses internationally, many of whom contribute to the economy of the country. However, I have observed that there are not enough nurse positions created in the Philippines to care for the nation’s numerous health problems, often associated with dire poverty. In Japan, the life expectancy is the highest in the world (World Health Organization, 2011), and the nursing shortage is complicated by long hospitalizations of patients. I have observed Japanese patients to be hospitalized for lengthy periods of time for relatively uncomplicated illnesses, operations, or accidents, when in many Westernized countries they would be discharged to recover at home. For example, one of my young, healthy students sustained an uncomplicated fracture of his tibia and fibula and stayed in hospital for 5 weeks to recover. This slower throughput of patients means that increased pressure is placed on the Japanese health system to find more health professionals to care for long stayers. Nursing shortages are numerous and complex, causing burnout, compromised care, and increased mortality and morbidity, but not all outcomes of shortages are negative. In my experience, shortages often create opportunities for nurses to develop different skills and knowledge, discard outdated and time-consuming practices, broaden career options, and create workable solutions to try to maintain high standards of patient care. Although the task may seem formidable, I believe that with strategic, cohesive, and collaborative efforts among nurses, locally, nationally, and internationally, we can help to assist in overcoming shortages. Certainly there are now more nurse leaders around the world focusing on the topics of recruitment and retention of staff, and developing leadership such as Huston (2008).Working as an editor-in-chief, I have discovered more nurse researchers are examining nursing shortages, recruitment, and retention from different aspects. Such efforts are essential to help make more nurses available for care; nurses who are prepared differently, who are safe, responsible, and responsive practitioners, better prepared for this century’s challenges and changes. Nursing and Health Sciences (2011), 13, 229–231

Writing about nursing policy and health policy.

Writing about nursing policy and health policy Too often as Editor, I receive journal submissions that do not focus on the aim and the scope of the International Nursing Review (INR). One reason is that often authors do not follow the Author Guidelines before submission. INR is ‘a quarterly, peer-reviewed journal that focuses predominantly on nursing policy, health policy, and social policy issues of relevance to nurses and midwives. The aim of INR is to forward ICN’s global mission by representing nursing, advancing the profession, and shaping health policy and nursing policy’ (International Nursing Review, 2015). INR is the official journal of the International Council of Nurses (ICN) which has a mandate to encourage nurses to be involved in decision making, planning and policy. One aspect of this is:

Nursing education: Preparing for the inevitability of disasters and emergencies

In this Special Issue of Nurse Education in Practice, nurses from Greece, China, the AsiaePacific and the USA have submitted their studies on disaster nursing. Their articles have a common and important theme: nursing needs to prepare better for the inevitability of disasters and emergencies through education and research. Although disaster nursing is firmly on the agenda in some countries, in many others nurses are underprepared, and there is a paucity of training programmes and disaster experts to help them. Disasters and emergencies of all kinds occur at random around the world, whether natural or manmade, and scientists warn that the frequency of natural disasters will increase apace in the years ahead with global warming. Already in the 21st century we have seen natural disasters have a huge impact on countries, communities and health services, especially in south-east Asia which is the most disaster-prone region in the world. All of us hope that disasters will not happen but such hoping is often based on our wish to have stability in our lives and to avoid the fear of a disaster, rather than facing up to reality, and this is bad risk-taking. While disaster planning, management and recovery efforts around the world have increased in the last two decades, many communities, organizations, and governments remain underprepared. Some put disaster planning into the too hard basket, while others lack resources to achieve capacity building and readiness. Sadly my observations are that these behaviours often happen in our nursing profession but it is critical that all nurses and other health professionals are educated to help when disaster strikes. It is clear that to develop disaster nursing education around the world we need to have more research to add to our knowledge base, including knowing what needs there are for preparing for different kinds of disasters, disaster management and mitigation, and how nurses can help communities prepare for and recover from disasters. From a practical viewpoint, trying to get disaster nursing education into curricula is often not easy, especially